The Effectiveness of Thoracic Spine Manipulation for the Management of Musculoskeletal Conditions: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Walser, Ronald F.; Meserve, Brent B.; Boucher, Thomas

doi:10.1179/106698109791352085

Cited by 82 publications

(70 citation statements)

References 55 publications

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“…There is sufficient evidence to support the use of thoracic spine manipulation for specific subgroups of patients with neck conditions. 37,38 Strengthening Exercises…”

Section: Thoracic Spine Manipulationmentioning

confidence: 99%

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Moustafa

Diab

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this study was to investigate the immediate and long-term effects of a 1-year multimodal program with the addition of 2 different traction approaches on the pain, function, disability, and nerve root function in patients with discogenic cervical radiculopathy (CR). This study also attempted to identify the optimal traction angle based on the maximum recovery of the peak-to-peak amplitude of the flexor carpi radialis (FCR) H-reflex. Methods: This randomized clinical trial with one-year follow-up included a total of 216 (101 female) patients with unilateral lower discogenic CR were randomly assigned to 1 of 3 groups. The standard care group (C) received the multimodal program (pain relief methods, muscle strengthening, and thoracic spine manipulation). The ventroflexion traction group (A) received the same multimodal program as group C, with added traditional ventroflexion traction. The novel traction group (B) received the same multimodal program as group C in addition to a flexor carpi radialis (FCR) H-reflex-based traction method. Primary outcomes were the Neck Disability Index (NDI) and secondary outcomes included neck pain, arm pain, and the amplitude and latency of the H-reflex. Patients were assessed at 3 intervals (pre-treatment, 4 weeks post-treatment, and the 1-year follow-up). Results: The mixed linear model with repeated measures indicated a significant group × time effect in favor of the novel cervical traction group (B) for measures of NDI (F = 412.6, P b .0005), neck pain (F = 108.9, P b .0005), arm pain (F = 91.3, P b .0005), H-reflex amplitude (F = 207.7, P b .0005), and H-reflex latency (F = 58.9 P b .0005). We found that the extension position of cervical spine (5°extension) was the position that achieved the maximum improvement in the novel cervical traction method. Conclusions: This preliminary study showed that a multimodal program with a novel cervical traction method added improved NDI, neck pain, arm pain, and the amplitude and latency of FCR H-reflex for a group of patients with chronic discogenic CR.

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“…There is sufficient evidence to support the use of thoracic spine manipulation for specific subgroups of patients with neck conditions. 37,38 Strengthening Exercises…”

Section: Thoracic Spine Manipulationmentioning

confidence: 99%

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Moustafa

Diab

2014

Journal of Chiropractic Medicine

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“…It has been proposed that neurophysiological effects of joint manipulation, along with induced biomechanical changes, may alter the inflow of sensory information to the central nervous system. 53,66 Existing evidence indicates that spinal manipulation impacts primary afferent neurons from paraspinal tissues, the motor control system, and pain processing. 23,53 Independent of the underlying mechanisms of spinal manipulation, there is general agreement Although both physiological and biomechanical effects are believed to result from TSM, its contribution to shoulder rehabilitation is unclear, and additional studies evaluating the effectiveness of TSM to treat shoulder conditions are necessary.…”

Section: T T Conclusion: Shoulder Pain In Individualsmentioning

confidence: 99%

Scapular Kinematics Pre– and Post–Thoracic Thrust Manipulation in Individuals With and Without Shoulder Impingement Symptoms: A Randomized Controlled Study

Haik¹,

Alburquerque‐Sendín²,

Silva³

et al. 2014

Journal of Orthopaedic & Sports Physical Therapy

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Shoulder pain is a common and debilitating condi tion, and its prevalence is second only to low back pain. 9,42,52,63 Shoulder im pingement syndrome (SIS) is the most frequently encountered shoulder condition and accounts for 44% to 65% of all shoulder pain. 63 A greater amount of scapular internal rotation, as well as a lesser amount of scapular upward rotation and posterior tilt during arm elevation, has previously been documented in individuals with symptoms of SIS compared to asymptomatic individuals. [35][36][37][38] These kinematic alterations have been associated with lesser activation of the middle and lower trapezius and serratus anterior muscles and excessive upper trapezius muscle activation. 37,51 Systematic literature reviews support the efficacy of therapeutic exercises for the rehabilitation of individuals with SIS, 29,43 and the results of randomized clinical trials suggest that providing manual therapy T T OBJECTIVES:To evaluate the immediate effects of a low-amplitude, high-velocity thrust thoracic spine manipulation (TSM) on pain and scapular kinematics during elevation and lowering of the arm in individuals with shoulder impingement syndrome (SIS). The secondary objective was to evaluate the immediate effects of TSM on scapular kinematics during elevation and lowering of the arm in individuals without symptoms. T T BACKGROUND:Considering the regional interdependence among the shoulder and the thoracic and cervical spines, TSM may improve pain and function in individuals with SIS. Comparing individuals with SIS to those without shoulder pathology may provide information on the effects of TSM specifically in those with SIS. T T METHODS:Fifty subjects (mean  SD age, 31.8  10.9 years) with SIS and 47 subjects (age, 25.8  5.0 years) asymptomatic for shoulder dysfunction were randomly assigned to 1 of 2 interventions: TSM or a sham intervention. Scapular kinematics were analyzed during elevation and lowering of the arm in the sagittal plane, and a numeric pain rating scale was used to assess shoulder pain during arm movement at preintervention and postintervention.

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“…9,15,16,24,65 The use of thrust manipulation applied to the thoracic spine has been shown to result in increased range of motion, decreased pain, and improvements in function in subgroups of individuals with mechanical neck and shoulder pain. [13][14][15][16]23,43,62,65 Biomechanical theories to explain the effects of spinal manipulation exist, yet the available data do not sufficiently explain how manipulation results in short-or long-term clinical benefits. 20,34,47,56 Researchers have attempted to identify which combination of clinical signs, symptoms, and other pertinent findings from the examination may predict a favorable response to spinal manipulation.…”

mentioning

confidence: 99%

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

Sparks

Cleland

Elliott³

et al. 2013

J Orthop Sports Phys Ther

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[ research report ] R ecently, in the physical therapy profession con siderable attention has been devoted to exam ining the effectiveness of spinal manipulation in clinical practice. 9,15,16,24,65 The use of thrust manipulation applied to the thoracic spine has been shown to result in increased range of motion, decreased pain, and improvements in function in subgroups of individuals with mechanical neck and shoulder pain. [13][14][15][16]23,43,62,65 Biomechanical theories to explain the effects of spinal manipulation exist, yet the available data do not sufficiently explain how manipulation results in short-or long-term clinical benefits. 20,34,47,56 Researchers have attempted to identify which combination of clinical signs, symptoms, and other pertinent findings from the examination may predict a favorable response to spinal manipulation. 13,43,57 A validation study of a proposed clinical decision rule to identify patients likely to respond to thoracic manipulation found that subjects with mechanical neck pain improved with T T STUDY DESIGN: Case series. T T OBJECTIVES:To use blood oxygenation leveldependent functional magnetic resonance imaging (fMRI) to determine if supraspinal activation in response to noxious mechanical stimuli varies preand post-thrust manipulation to the thoracic spine. T T BACKGROUND:Recent studies have demonstrated the effectiveness of thoracic thrust manipulation in reducing pain and improving function in some individuals with neck and shoulder pain. However, the mechanisms by which manipulation exerts such effects remain largely unexplained. The use of fMRI in the animal model has revealed a decrease in cortical activity in response to noxious stimuli following manual joint mobilization. Supraspinal mediation contributing to hypoalgesia in humans may be triggered following spinal manipulation. T T METHODS: Ten healthy volunteers (5 women, 5men) between the ages of 23 and 48 years (mean, 31.2 years) were recruited. Subjects underwent fMRI scanning while receiving noxious stimuli applied to the cuticle of the index finger at a rate of 1 Hz for periods of 15 seconds, alternating with periods of 15 seconds without stimuli, for a total duration of 5 minutes. Subjects then received a supine thrust manipulation directed to the midthoracic spine and were immediately returned to the scanner for reimaging with a second delivery of noxious stimuli. An 11-point numeric pain rating scale was administered immediately after the application of noxious stimuli, premanipulation and postmanipulation. Blood oxygenation level-dependent fMRI recorded the cerebral hemodynamic response to the painful stimuli premanipulation and postmanipulation. T T RESULTS:The data indicated a significant reduction in subjects' perception of pain (P<.01), as well as a reduction in cerebral blood flow as measured by the blood oxygenation level-dependent response following manipulation to areas associated with the pain matrix (P<.05). There was a significant relationship between reduced activation in the insular cortex and d...

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The Effectiveness of Thoracic Spine Manipulation for the Management of Musculoskeletal Conditions: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Cited by 82 publications

References 55 publications

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Scapular Kinematics Pre– and Post–Thoracic Thrust Manipulation in Individuals With and Without Shoulder Impingement Symptoms: A Randomized Controlled Study

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

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